Question 69

Hysterectomy and UTI and Failure of Estratest to Restore Libido

Dear Doctor N,

I had a total vaginal hysterectomy in April of 99; and ever since, I have been plagued with UTI's. My doctor insists there is no connection, but both my sister and niece (who've also had hysterectomies) suffer the same problems. I am on 0.5 mg Estrace/day; they are both on Estratest. I have tried Estratest, but do not like it...it is too expensive, it has not helped my lack of libido, and I'm gaining weight at the ratae of 5 lbs. per month. Also, I have heard that it raises your cholesterol. I've seen three different doctors, and none of them seem to be able to help with my problems with UTI. They put me on a regimen of one antibiotic or another, from which I get relief, but in a month or so, the infection returns. Sometimes I get an infection without symptoms, and I'm afraid that it will eventually lead to kidney problems. I take 500 mg of Vit. C and cranberry capsules to help keep my urinary tract acid. I am scrupulously clean, and take care to wipe from front to back. I NEVER had urinary tract infections until post hysterectomy. What can I do to prevent them?

Reply:

I am sorry that you are having these problems.

• The frequent UTI's that may occur following hysterectomy may require long-term and/or maintenance antibiotic therapy and you should consult with a urologist and discuss this point.
• I believe that weight gain is more frequent in all oral HRT as opposed to non oral.
• Oral HRT even those medications such as Estratest often do not restore libido and a non oral route such as transdermal estradiol/testosterone gel that is applied to the skin, or subcutaneous hormone implants may be required.

Read the sections of the web site under the Sex, Hysterectomy and HRT headings and question 52 in the Ask Dr N section of the web site as they address these issues in some detail. You can access them from their links on the main menu of the home page. www.drn4u.com

Dr N